Tips and Tricks:
- Performed perineorrhaphy 1st (may be as sometimes difficult at the end, sling?).
- He used Si, with left side docking ( >10 cm apart, 8 mm x 3, 12 mm camera port( preplace suture), 11 mm assistant port)
- #1 for monopolar scissors, #2 Maryland bipolar forceps, #3 Fenestrated graspers/prograsp.
- Lysis of adhesion.
- Peritoneal Trough rather than tunnel.
- Anterior plane dissection: standard
- Posterior plane.
- Y shape mesh
- Anterior mesh suturing with ethibon interrupted sutures ( 3 sutures /2 rows)
- Suture posterior part
- Fixed the tail of the mesh into the anterior longitudinal ligament (2-3 stitches)
- Retropertonealzed the mesh with delayed absorbable suture( v lock)
- Additional vaginal work first? Think
- Preplace sutures for camera port
- Comprehensive adhesiolysis
- Tactile confirmation of promontory
- Separated assistant for vaginal manipulation
- Peritoneal cap on apex
- Bladder muscularis visible
Presented by: Alex Gomelsky, MD, LSU health- Shreveport
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas